title: Improving access to acute stroke therapies: a controlled trial of organised pre-hospital and emergency care.
abstract: OBJECTIVE
  To assess the effectiveness of the PAST (Pre-hospital Acute Stroke Triage) protocol in reducing pre-hospital and emergency department (ED) delays to patients receiving organised acute stroke care, thereby increasing access to thrombolytic therapy.
  
  
  METHODS
  Prospective cohort study using historical controls.
  
  
  METHODS
  Hunter Region of New South Wales, September 2005 to March 2006 (pre-intervention) and September 2006 to March 2007 (post-intervention).
  
  
  METHODS
  Consecutive patients presenting with acute stroke to a regional, tertiary referral hospital.
  
  
  METHODS
  PAST protocol, comprising a pre-hospital stroke assessment tool for ambulance officers, an ambulance protocol for hospital bypass for potentially thrombolysis-eligible patients, and pre-hospital notification of the acute stroke team.
  
  
  METHODS
  Proportion of patients who received intravenous tissue plasminogen activator (tPA), process of care time points (symptom onset to ED arrival, ED arrival to tPA treatment, and ED transit time), and clinical outcomes of patients treated with tPA.
  
  
  RESULTS
  The proportion of ischaemic stroke patients treated with tPA increased from 4.7% (pre-intervention) to 21.4% (post-intervention) (P < 0.001). Time point outcomes also improved, with a reduction in median times from symptom onset to ED arrival from 150 to 90.5 min (P = 0.004) and from ED arrival to stroke unit admission from 361 to 232.5 minutes (P < 0.001). Of those treated with tPA, 43% had minimal or no disability at 3 months.
  
  
  CONCLUSIONS
  Organised pre-hospital and ED acute stroke care increases patient access to tPA treatment, which is proven to reduce stroke-related disability.
authors.affiliation: Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Debbie A
authors.initials: DA
authors.lastname: Quain
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
authors.forename: Allan R
authors.initials: AR
authors.lastname: Loudfoot
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Spratt
authors.forename: Malcolm K
authors.initials: MK
authors.lastname: Evans
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Russell
authors.forename: Angela T
authors.initials: AT
authors.lastname: Royan
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Moore
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Miteff
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Hullick
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Levi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care; D020521:Stroke / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014218:Triage / Q000458:organization & administration*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator